Elsevier

Appetite

Volume 91, 1 August 2015, Pages 200-208
Appetite

Research report
Health literacy and parent attitudes about weight control for children

https://doi.org/10.1016/j.appet.2015.04.010Get rights and content

Highlights

  • Weight loss information sources and strategies endorsed by parents were assessed.

  • We compared parents with low and adequate health literacy (HL).

  • Parents with low HL endorsed fewer recommended and fewer strategies overall.

  • Low HL parents were less likely to search Internet and more likely to consult clergy.

  • Parental HL impacts weight loss attitudes and information in the home.

Abstract

The purpose of this study was to examine associations between parental health literacy and parent attitudes about weight control strategies for young children. Parental low health literacy has been associated with poor child health outcomes, yet little is known about its relationship to child weight control and weight-related health information-seeking preferences. Data were drawn from the STRONG Kids Study, a Midwest panel survey among parents of preschool aged children (n = 497). Parents endorsed an average of 4.3 (SD =2.8) weight loss strategies, 53% endorsed all three recommended weight loss strategies for children, and fewer than 1% of parents endorsed any unsafe strategies. Parents were most likely to seek child weight loss information from healthcare professionals but those with low (vs. adequate) health literacy were significantly less likely to use the Internet or books and more likely to use minister/clergy as sources. Poisson and logistic regressions showed that higher health literacy was associated with endorsement of more strategies overall, more recommended strategies, and greater odds of endorsing each specific recommended strategy for child weight control, after adjusting for parent age, education, race/ethnicity, income, marital status, weight concern, and child BMI percentile. Findings suggest that health literacy impacts parental views about child weight loss strategies and health information-seeking preferences. Pediatric weight loss advice to parents should include assessment of parent attitudes and prior knowledge about child weight control and facilitate parent access to reliable sources of evidence-informed child weight control information.

Introduction

Health literacy is the degree to which an individual has the capacity to obtain, understand, communicate, and apply basic health information and services to improve one's health (Centers for Disease Control and Prevention, 2015). About 36% of adults in the USA have inadequate health literacy (Kutner, Greenberg, Jin, & Paulsen, 2006). Health literacy is viewed somewhat differently in medical and public health contexts (Nutbeam, 2000). In medical contexts, low health literacy is viewed as a barrier to healthcare and treatment adherence, requiring that providers and healthcare organizations adapt to become more accessible and user-friendly (Liechty, 2011). In public health contexts, health literacy is viewed as an opportunity for education and empowerment, a capacity-building challenge to enable persons to exercise more agency in their lives and better utilize health information and services (Nutbeam, 2000). Public health literacy also encompasses skills in evaluating public health information and the ability to apply it in ways that impact small groups and entire communities rather than individual health alone (Freedman et al., 2009). To date, most health literacy research has been individually and clinically focused, leaving a gap in our understanding of its family health implications. Improving the health literacy of a parent can affect health behaviors and outcomes for the entire family, and studying early family influences on weight-related health has been identified as a national priority (National Institutes of Health Obesity Research Task Force, 2011). This study examines the impact of parental health literacy on weight-related information-seeking and parental attitudes toward weight control among young children, with implications for both public health and healthcare practice.

Section snippets

Parental health literacy, child health, and child weight

Among adults, low health literacy has been associated with poorer health status and poorer health outcomes such as lower medical adherence, lower awareness of medical condition, longer hospital stays, and greater use of the Emergency Department (Agency for Healthcare Research and Quality, 2011, Nielsen-Bohlman et al, 2004). Low health literacy among parents has also been found to be associated with poor child health outcomes (DeWalt, Dilling, Rosenthal, & Pignone, 2007) and may be a driver of

Information and recommendations on weight loss strategies for children

One of the key components of healthy literacy is the ability to obtain and understand health information, but little is known about where parents look for information regarding child weight loss strategies, or if preferred sources differ by level of parental health literacy. The American Academy of Pediatrics (AAP) issued evidenced-based recommendations for the prevention and treatment of overweight and obesity among children and many of the strategies are directed to parents and the home

Data and participants

Data were drawn from a larger study, STRONG Kids, a prospective, longitudinal panel study that followed preschool age children and primary caregiver (n = 497 pairs) over 3 waves beginning in 2009 (Harrison et al., 2011). The study and sampling design have been described elsewhere (Harrison & Liechty, 2012). We used cross-sectional data from Wave 1 (W1) for this study. The study was approved by the Institutional Review Board of the University of Illinois. Parents in the study were 89.7% female

Results

One in six parents (16%) in this sample had low health literacy. Parents endorsed an average of 4.3 (SD =2.8) weight loss strategies. Overall, 53% endorsed all three recommended weight loss strategies for children, and this rate was higher among parents with adequate (58%) versus low health literacy (24%). In addition, nearly a third (31%) of parents with low health literacy did not mark any of the recommended strategies compared to 11% of their counterparts. Most parents (69%) expressed

Discussion

This study is among the first to describe attitudes toward a variety of specific weight loss strategies among parents of young children, and to our knowledge, the first to find that health literacy is associated with parental attitudes toward specific weight control strategies. Parental health literacy was positively associated with endorsement of recommended weight loss strategies (e.g., increasing fruit and vegetables and physical activity, and decreasing fat intake), and the number of

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    Acknowledgements: This research was funded, in part, by grants from the Illinois Council for Agriculture Research to Kristen Harrison (PI), the University of Illinois Health and Wellness Initiative to Barbara Fiese and Sharon Donovan (Co-PIs), and the U.S. Department of Agriculture (Hatch 793-328) to Barbara Fiese (PI). Jaclyn Saltzman was supported by the National Institute for Agriculture under the Illinois Transdisciplinary Obesity Prevention Program (I-TOPP) training grant (2011-67001-30101) to the Division of Nutritional Sciences at the University of Illinois. The authors would like to acknowledge the STRONG Kids Team for data collection and design of the parent study. The STRONG Kids Team includes Kristen Harrison, Kelly Bost, Brent McBride, Sharon Donovan, Diana Grigsby-Toussaint, Juhee Kim, Janet Liechty, Angela Wiley, Margarita Teran-Garcia and Barbara Fiese.

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